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Guidelines for diagnosing coeliac disease: European Society Paediatric Gastroenterology, Hepatology and Nutrition
  1. Sarah Berry1,
  2. Naomi McMahon2,
  3. Jonathan Henderson1
  1. 1 Paediatrics, Southern Health and Social Care Trust, Portadown, UK
  2. 2 Paediatric Gastroenterology, Royal Belfast Hospital for Sick Children, Belfast, UK
  1. Correspondence to Dr Sarah Berry, Paediatrics, Southern Health and Social Care Trust, Portadown, Craigavon BT63 5QQ, UK; s.berry{at}

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Coeliac disease (CD) is a lifelong, immune-mediated, systemic disease precipitated by exposure to dietary gluten in genetically predisposed individuals. It affects all age groups with a diverse range of clinical signs and symptoms.1 Over the past five decades, there has been a fourfold increase in the incidence of CD in the UK, which is largely due to increased disease awareness, advances in diagnostic tests and development of screening programmes. However, data from recent population-based studies suggest that at least 1 in 100 people in the UK are affected by CD, meaning approximately 70% (500 000 people) remain undiagnosed, showing further improvements need to be made.2–4

Information about the new (2020) guideline

In January 2020, the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) published new evidence-based guidelines for diagnosing CD in children. The 2012 ESPGHAN and the 2016 NICE guidelines on CD were used to develop 10 focused, clinical questions using the PICO (population, indicator, comparator and outcome) format.(see box 1). For each question, a thorough review of current evidence was systemically analysed, overall strength of the evidence evaluated and discussed among the workgroup for relevance and implications to clinical practice. From this, a responding recommendation was formulated, which was graded for strength according to the GRADE approach.5

Box 1

Questions for the 2020 European Society Paediatric Gastroenterology, Hepatology and Nutrition criteria for the diagnosis of CD5

  1. Is there a difference in the prevalence of CD in children with constipation, abdominal pain, signs of IBS, dyspepsia, malabsorption, iron deficiency anaemia or oral aphthae compared with the general population?

  2. What will HLA-DQ2 and DQ8 determination add to the diagnostic certainty of CD-diagnosis?

  3. Does the algorithm proposed to avoid biopsies in symptomatic patients work in asymptomatic subjects?

  4. Which serological test is the most appropriate to diagnose CD?

  5. Should more than one serological test be used and, if so, what should the sequence of testing be?

  6. At which cut-off for IgA antibodies against type-2 …

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  • Contributors SB was the main author for this piece. NM and JH reviewed the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.